Hand and Wrist RMSK

Question 1

Wrist joints

Answer 1

radiocarpal, midcapal, distal radioulnar

Question 2

Contens of carpal tunnel

Answer 2

Median nerve, FDS, FDP, FPL

Question 3

Roof of carpal tunnel is the

Answer 3

flexor retinaculum

Question 4

Carpal tunnel inlet

Answer 4

scaphoid and pisiform

Question 5

Carpal tunnel outlet

Answer 5

Trapezium and Hamate

Question 6

Dorsal compartments how many? Name all

Answer 6

six 1 (APL,EPB) 2(ECRL,ECRB) 3 (EPL) 4(EDC, EIP) 5(EDMinimi) 6(ECU)

Question 7

Where does the FDS split and insert

Answer 7

splits at PIP joint, inserts at middle phalanx

Question 8

Insertion of Extensor Digitorum tendon

Answer 8

middle phalanx as a central band.

Question 9

Nerve fascicle appearance

Answer 9

hypoechoic fasicle. hyperechoic surrounding connevtive tissue

Question 10

Median nerve appearance tunnel vs forearm

Answer 10

Hypoechoic at tunnel, hyperechoic forearm

Question 11

Where does the palmar cutaneous branch of the median nerve go

Answer 11

superficial to flexor retinaculum and ULNAR to FCR tendon

Question 12

Thenar motor branch landmark

Answer 12

from palmar ulnar aspect of radial division of median nerve. extending proximal between the APB and FPB.

Question 13

Palmaris longus

Answer 13

directly superficial to median nerve

Question 14

Nerves found in dorsal extensor compartment 1

Answer 14

superficial radial nerve

Question 15

Nerve found at the 4th dorsal compartment

Answer 15

Posterior interosseous nerve

Question 16

ECU tendon has a normal thin hypoechoic longitudinal cleft

Answer 16

not a tear

Question 17

ECU tendon located outside groove

Answer 17

50% of the time is outside.. still normal

Question 18

Extensor retinaculum measurement

Answer 18

1.7mm thick and 23mm wide in Cross section

Question 19

What plane is the distal radioulnar joint seen?

Answer 19

transverse

Question 20

What plane is the radiocarpal and midcarpal joint recess seen

Answer 20

sagittal

Question 21

Landmark for finding the scapholunate ligament

Answer 21

distal to Listers tubercle

Question 22

Superficial to the dorsal scapholunate ligament what structure?

Answer 22

dorsal radiocarpal ligament is seen.. common site for wrist ganglion

Question 23

What comprises TFCC

Answer 23

cartilage, meniscus, ECU tendon sheath, ulnar and dorsal radiocarpal ligament

Question 24

vascular landmark near superficial radial nerve

Answer 24

cephalic vein

Question 25

Appearance of pulleys on ultrasound

Answer 25

trilaminar.. superficial reflectiv surface . hypoechoic pulley, hyper reflective surface of adjacent tendon sheath

Question 26

A1 pulley location

Answer 26

MCP

Question 27

A2 pulley location

Answer 27

PP

Question 28

A3 pulley location

Answer 28

PIP joint

Question 29

A4 pulley location

Answer 29

MP

Question 30

Where can you find the ulnar collateral ligament of the thumb? landmark

Answer 30

MP joint and PP..

Question 31

structure superficial to UCL of thumb

Answer 31

adductor pollicis aponeurosis- moves with flexion of IP joint 

Question 32

What dynamic test for UCL

Answer 32

valgus for ulnar ligaments and varus for radial ligaments

Question 33

Joint recess distenstion anechoic

Answer 33

simple fluid

Question 34

Joint recess distention NOT anechoic what are your considerations?

Answer 34

compelx fluid and synovial hypertrophy

Question 35

Complex fluid characteristics

Answer 35

compressible, swirling echoes, NO INTERNAL FLOW ON DOPPLER

Question 36

Synovial hypertrophy considerations

Answer 36

LITTLE compressibility, No displacement. + with internal flow on doppler , hypoechoic or (less frequyently iso or hyper compared to adjacent subdermal fat)

Question 37

typical characteristic of a ganglion cyst

Answer 37

MULTILOCULAR & NON COMPRESSIBLE

Question 38

active inflammatory synovitis

Answer 38

hypoechoic with hyperemia on color doppler imaging 

Question 39

RA hand and wrist protocol

Answer 39

three joints of each wrist ( radioulnar, radio carpal, midcarpal) MCP joints of each index and long fingers PIP of index and long fingers 

Question 40

what is paratendinitis

Answer 40

inflammation of a tendon that has no tendon sheath 

Question 41

Tenosynovitis erosions in RA region in hand 

Answer 41

ulnar styloid 

Question 42

RA early assessment ofwhich tendons

Answer 42

ECU and second flexortendon 

Question 43

proximal intersection syndrome involvement and location

Answer 43

4-8cm PROXIMAL to listers. APL EPB and ECRB and ECRL (1st and 2nd dorsal)

Question 44

accessory muscles of hand

Answer 44

accessory ABDUCTOR DIGITI MINIMI - Ulnar nerve entrapment, Extensor digitorum brevis manus, palmaris longus

Question 45

normal CSA of median nerve

Answer 45

< 6 if >12mm CTS...

Question 46

Measurement of bifid median nerve

Answer 46

combined CSA has difference of 4mm2 comparing PQ and DISTAL carpal tunnel 

Question 47

Hypothenar hammer syndrome cause

Answer 47

thrombus 

Question 48

fatty median nerve mass

Answer 48

fibrohamaroma median nerve 

Question 49

Compression of superficial radial nerve at distal forearm syndrome

Answer 49

wartenburg 

Question 50

Appearance of abnormal TFCC

Answer 50

abnormal hypoecho, thinning or absence.

Question 51

Interosseous membrance bet. radius and ulna tears called

Answer 51

essex-lopresti injury ( comminutedradial head fracture at elbow with interosseous injury and distal radioulnar joint disruption)

Question 52

Difference between fracture and cortical irregularity

Answer 52

step-off deformity is specific (radiographic correlation is essential) hyperemia, and point tenderness 

Question 53

ganglion cyst echogenic considerations

Answer 53

usually with increased through transmission